The "Childmyths" blog is a spin-off of Jean Mercer's book "Thinking Critically About Child Development: Examining Myths & Misunderstandings"(Sage, 2015; third edition). The blog focuses on parsing mistaken beliefs that can influence people's decisions about childrearing-- for example, beliefs about day care, about punishment, about child psychotherapies, and about adoption.
See also http://thestudyofnonsense.blogspot.com

Concerned About Unconventional Mental Health Interventions?

Monday, May 20, 2013

International Concerns with Holding Therapy

The following material summarizes the work of a conference that discussed Holding Therapy and similar interventions as they continue to be used and in fact spread into new territory. The report has been sent to a list of professionals and officials involved with child welfare. Readers are invited to comment and to send a link to persons who may be interested.

Summary
Report of the Meeting

of the International Working Group on Abuses
in Child Psychotherapy, 20 April 2013

All over the world, psychologists and social workers
deplore child abuse and work to prevent it. Paradoxically, however, a small
number of mental health practitioners choose to use a treatment that has been
described as abusive and has been associated with a number of child injuries
and deaths. This treatment, usually called “holding therapy” (HT) (or “attachment
therapy” [AT]), uses prolonged physical restraint in various forms as a
therapeutic method. HT appears to have originated in the United States but has
spread internationally as a treatment for autism and for attachment disorders.
In response to the spread of HT, concerned individuals from the United States,
the United Kingdom, the Czech Republic, and Russia have formed the
International Working Group on Abuses in Child Psychotherapy with the goal of
public and professional education about HT and prevention of its use. The group
met in London on 20 April 2013. This document summarizes background information
and the presentations made at the conference, which without exception argued
against the use of HT.

Background

International attention was attracted to the problem of
HT in 2000 when a 10-year-old American girl died in the course of treatment.
Other deaths, caused by parents following the advice of therapists, have been
less well publicized (Mercer, Sarner, & Rosa, 2003). In the United States,
a Congressional resolution rejected the use of one component of HT; the
American Psychological Association, the American Psychiatric Association, the
National Association of Social Workers, and other groups joined in this
opinion. In the United Kingdom, the British Association for Adoption and
Fostering passed a similar resolution in 2004. The American Professional
Society on Abuse of Children (APSAC) mounted a task force to investigate the
use of HT and published a report (Chaffin et al., 2006) rejecting the use of
the treatment or related methods. The absence of an evidence basis for HT has
been noted (Mercer, 2013).

In spite of these rejections, practitioners in several
countries have continued to use or support HT in its various forms. The U.S. organization Association for
Treatment and Training of Attachment in Children (ATTACh), at one time the
leading advocacy group for intrusive HT, has now redefined holding of children
as a nurturing approach. In 2010, Adam
Pertman, executive director of the Evan B. Donaldson Adoption Institute, a
leading U.S. adoption organization, stated approval in an Institute publication
of a HT-based treatment publicized in a made-for-TV movie. In the U.K.,
professional publications (Howe & Fearnley, 2003; Sudbery, Shardlow, &
Huntington, 2010) have argued in favor of HT, and a survivor of the treatment
has come forward to describe his experiences (Chaika, 2012) . In the Czech
Republic, a form of HT has been promoted by the psychologist Jirina Prekopova,
who practiced the method in Germany for 20 years, and who has the support of
Jaroslav Sturma of the Czech-Moravian Association of Psychologists. A Russian
adoption group recently invited a well-known U.S. HT proponent to visit, and HT
books have been translated into Russian.

Forms
of HT and their implications

HT exists in several forms, all of which involve physical
restraint of children by adults. The original form practiced in the U.S.
(Zaslow & Menta, 1975) was brutally intrusive and is known to have caused
at least one adult death as well as death and injury to children. It was
originally directed toward treatment of autism but later focused on disorders
of attachment as defined by HT proponents. Following the 2000 child death
mentioned earlier, HT advocates reworked their methods and reported that
holding was done only with the child’s agreement. Both the original and the
revised forms were often accompanied by parent and foster parent practices that
involved withholding of food and water, limitation of toilet use, demands for hard
physical tasks, and other efforts to demonstrate adult authority.

An alternative form of HT was advocated by Welch (1989)
with the encouragement of the Nobel laureate Nikolaas Tinbergen and was adopted
by Jirina Prekopova. This method involves restraint of a child by the mother,
either in a face-to-face embrace for smaller children or with the mother lying
prone on the supine child. The period of restraint lasts an hour or more and is
to be carried out every day as a treatment for autism or oppositional behavior.
As far as is known, Prekopova’s method is not accompanied by the parenting
practices described in the previous paragraph.

No acceptable outcome research has provided evidence to
support the use of any HT form. Use of HT methods involves risk of physical
harm in some cases, and risk of a failure to treat serious emotional problems
by means of evidence-based practices in all cases.

Presentations
at the London conference

At the meeting of the International Working Group in
London, presentations were made by a British social worker and a British
barrister, a Czech psychologist and a Czech activist, an American psychologist,
and a Russian biochemist with an interest in cult-like activities. It will be
notable in the summaries to follow, that two presenters chose to be identified
by assumed names out of concern for professional and personal repercussions
that might follow their speaking out.

“Anya
Chaika”, a British social worker and author of Invisible England, discussed a British case in which a boy had
been subjected to HT while under the care of a major provider of
residential children’s homes. As a teenager, the boy was moved from the
residential treatment center to foster care provided by the person who had
been his therapist in the center, and was persuaded by her to change his
surname to hers. “Chaika” was contacted by the now-adult former patient
after becoming aware that the organization was using HT and starting a
blog to try to collect information about the practice. The former patient
has been able to bring a lawsuit against the children’s homes organization
and this suit is in progress.

Lucinda
Davis, a British barrister, commented on legal issues concerning child
abuse of any kind, and ways in which child abuse laws could be used
against the practice of HT. Discussing the differences between tort law
and human rights law, she noted that British or Czech cases needed to be
approached initially as involving torts, with appeal to the European Court
of Human Rights possible only after all other appeals were exhausted. As
is the case in all the common law countries, the practice of HT can be
attacked legally in Britain only when actual harm to the child can be
demonstrated or assumed. Physical restraint methods are not in themselves
prohibited by law.

“Mrs.
Alena”, a Czech autism activist, described the history of HT as performed
by Jirina Prekopova and her students. Prekopova, who had practiced HT in
Germany (where she worked with the alternative psychotherapist Bert
Hellinger), returned to the Czech Republic in the 1990s and in 2001
developed a HT working group as part of the Czech-Moravian Psychological
Society. A movement against HT began following the broadcast of a
documentary film praising the method, but Prekopova has continued to
receive the support of the Catholic Church, government officials, the
Ministry of Education, the “Our
Child” Foundation, and the president of the Czech-Moravian Psychological
Society. Prekopova has created outreach programs in Slovakia, Austria,
Mexico, Venezuela, Spain, and Italy.

Katerina
Thorova, a Czech psychologist, discussed psychological mechanisms that
might lead parents to the choice of alternative psychotherapies like HT.
Thorova emphasized the role of a social climate that is friendly to occult
and pseudoscientific beliefs. She described a wide range of problems for
which Prekopova recommends HT, including autism, attachment disorders,
attention deficit hyperactivity disorder, oppositional and defiant
disorder, and conduct disorder. Prekopova’s presentation of HT has
cult-like features, attracts the public by manipulative techniques
involving logical fallacies, “global truths”, and false analogies. HT
propaganda appeals to emotion and proposes a universal solution of “love”
for most problems. Because people are subject to cognitive and
confirmation biases, cognitive dissonance, and the desire to comply with
authority, they find it difficult to resist the appeal of HT.

Jean
Mercer, an American psychologist, discussed claims that Prekopova’s HT
method was based on scientific evidence. These claims were originally
based on the support for HT given by the Nobel laureate Nikolaas
Tinbergen, whose ethological studies suggested that specific experiences
could direct personality development. In the 1980s, Prekopova and German
colleagues published several articles concluding that HT was demonstrated
to be an effective treatment, but all of the studies were inadequate in
that they had small Ns, the outcome measures were vaguely defined, and the
outcome measures depended on parent judgments. Scientific support for
Prekopova’s HT method, like that for other HT techniques, is extremely
weak, and indeed Prekopova has dropped claims about scientific evidence
and today presents religious and spiritual arguments in favor of her
practices.

On
behalf of Yulia Massino, a Russian biochemist who attended by Skype, Jean
Mercer discussed the intrusion of U.S. HT advocates into Russia at the
invitation of some cult-like groups. The major concern of this
presentation was the use of “parenting” techniques adjuvant to HT, as
recommended by the HT advocate Nancy Thomas, who recommends the
establishment of adult authority by parental control of a child’s food,
drink, toilet use, and exposure to cold, heat, or darkness. These methods
have been associated with malnutrition and in some cases with child death.
Books by Thomas and other HT proponents have been translated into Russian.
Nancy Thomas visited and lectured in Russia in 2012 at the invitation of
an American Pentecostal minister.

Conclusion

The International Working Group concluded that HT methods
are neither safe nor effective as treatments of childhood mental illness, and
that their spread internationally is an alarming phenomenon that should be
recognized and countered by professional and parent groups. What can and cannot
be done about this problem?

Legal challenges to HT
have so far been ineffective in common law countries, where freedom of speech
issues are privileged. Professional groups have opposed specific legislation
about HT methods, claiming that they can regulate members of their own
disciplines. In addition, it is difficult to write legislation that describes
HT methods in such a way that a change of language or a minor change in methods
cannot evade a prohibition. Where government appears to support HT, as in the
Czech Republic, legal challenges would seem of little use.

Professional and public education on the existence and
nature of HT methods may be the most effective way to reduce the use of these
treatments. However, in the U.S., efforts by professional groups occurred after
a well-publicized child death and diminished within a few years. With respect
to the almost-nonexistent public education about the HT problem, it should be
noted that HT proponents in several countries have for years bombarded the
public with propaganda in the form of television “documentaries” and films, and
that journalists have contributed to these persuasive efforts by assuming that
statements by HT advocates are accurate.

What is really needed is for professional groups to mount
a proactive campaign of education about HT, rather than waiting for harm to
another “poster child”. This will require the kind of political will that
usually exists only when a few members of a group are convinced of the need to
solve a problem. Such a campaign needs to direct accurate information to mental
health professionals and to take into consideration the emotional arguments to
the public that, as Dr. Thorova noted, have been effective in persuading
parents to accept HT.

The International Working Group has taken a small step in
the direction of professional and public education and is now asking mental
health professionals and professional organizations to join in this work.

2 comments:

Hey, Jean, how are you?It's Jeff, the "punishment is abuse/no punishing" guy. I'm at thejmcguires@Telus.net.I've written my book. Any chance you know a publisher who might give a darn about it?Might you be curious to see it, or the proposal yourself?

Thanks,

(I suppose I could have found another way to contact you, but I thought if you were going to remember me it would be from here . . . )

About Me https://en.wikipedia.org/wiki/Jean_Mercer

Jean Mercer has a Ph.D in Psychology from Brandeis University, earned when that institution was 20 years old (you do the math). She is Professor Emerita of Psychology at Richard Stockton College, where for many years she taught developmental psychology, research methods, perception, and history of psychology. Since about 2000 her focus has been on potentially dangerous child psychotherapies, and she has published several related books and a number of articles in professional journals.
Her CV can be seen at http://childmyths.blogspot.com/2009/12/curriculum-vitae-jean.mercer-richard.html.